Menopause in India: An Overlooked Health Challenge Amidst Societal Taboos

Studies indicate that Indian women typically reach menopause several years earlier than their Western counterparts. A recent paper also revealed a rise in premature menopause, particularly among women aged 30 to 39. Despite this trend, there are limited resources available to assist them. Dr. Ruma Satwik, a gynaecologist and obstetrician at Delhi’s Sir Gangaram Hospital, noted, “In some studies, the average age of menopause in India is 47 – meaning some women can hit it by 44-45 while others by 50 and this is considered normal.” This average is notably earlier than in countries like the US, where the average age is 51. Medical professionals suggest that earlier menopause results from a combination of nutritional, environmental, and genetic factors. However, in a country where discussions about menstruation still carry stigma and taboo, awareness surrounding menopause remains insufficient. Sangeeta, who uses a single name, experiences daily overwhelm as she manages work, household chores, and childcare, all while enduring severe hot flushes, fatigue, insomnia, backache, and abdominal pain. The 43-year-old questioned, “What’s the point of living like this?” adding, “Sometimes I feel my pain will end when I die.” Ms. Sangeeta, a janitor at Dr. Ram Manohar Lohia Hospital, a government-run facility in Delhi, began menopause a year ago but only recently learned that the hospital had a dedicated clinic to address related health concerns. Hundreds of miles away in Mumbai, the financial capital, Mini Mathur reported experiencing “every possible” symptom after turning 50. The TV host stated she had no prior medical issues and maintained a healthy lifestyle. The sudden onset of symptoms brought to mind advice a friend had given her years ago: “It’s coming for everyone. Please hit the ground running.” India’s 2011 Census data showed 96 million women over 45 years old. Dr. Anju Soni, president of the Indian Menopause Society, projects this number to reach 400 million by 2026. She stated, “Indian women live one-third of their life after menopause.” Women are considered to have reached menopause when they have not menstruated for a year. This stage is preceded by perimenopause, a phase of gradual decline in reproductive hormones that can last anywhere from two to 10 years. Symptoms are wide-ranging, affecting mood, memory, focus, and libido, as well as impacting bone, brain, muscle, skin, and hair. Depending on their severity, women may experience a decline in their quality of life. Doctors explain that most symptoms are manageable with supplements, dietary adjustments, exercise, and, if necessary, hormone replacement therapy. However, there are no specific tests to diagnose the condition, so medical professionals typically rely on eliminating other causes for the symptoms. Doctors also note that menopause and perimenopause are globally under-researched, with very little taught about them in medical school. Dr. Satwik commented that this situation can make the diagnostic process quite frustrating for women. Ms. Mathur recounted that it took visits to several healthcare centers across the country and abroad over two years before she received the necessary care. She was surprised to find that many of her symptoms—including brain fog, low mood, joint pain, and anxiety—became “vastly better” when she started using progesterone cream topically. She stated, “I had to go to Austria to find a doctor who wouldn’t negate my symptoms and feelings and say ‘sabko hota hai [it happens to everyone]’.” This sentiment is familiar to 60-year-old activist Atul Sharma, who was so concerned about the menopausal changes affecting her mood and sex drive that she concealed the condition from her husband for nearly six years. Ms. Sharma, who works with women in rural areas on health and economic empowerment in northern Uttar Pradesh state, observed a severe lack of provisions for menopausal women at rural government clinics. She noted that primary healthcare workers, despite wanting to help, lacked specialized training. She quoted a nurse: “Even the nurse who comes here says, ‘Ab iske liye bhi davai mangogi [now you will seek medicine for this also]? Just bear it with. It happens to every woman’.” Between 2022 and 2024, Dr. Satwik surveyed over 370 women aged 40 to 60 regarding their symptoms and their intensity. She reported, “About 20% experienced nothing at all. The rest experienced one or more symptoms mildly while 15-20% were experiencing it to a severe degree.” With limited information available within India, many women are increasingly turning to social media, finding online resources often more informative than discussions with their doctors. Many follow American specialists like Dr. Mary Claire Haver, who shares recent research on social media, and celebrities like Hollywood actresses Naomi Watts and Halle Berry, who have promoted the documentary *The M Factor: Shredding the Silence on Menopause*. Watts is currently writing a book on menopause, while Berry is advocating for new legislation to promote its research, training, and education. Ms. Mathur expressed feeling privileged to have accessed treatment. She questioned, “How are women who are bringing up families, kids, going to work, travelling in packed local trains dealing with it?” She added, “We are not up to date with the West,” and “We don’t have enough brands of oestrogen patches and progesterone creams that we need in India.” She is currently pursuing a course in the US, certified by the National Board of Health and Wellness Coaches, with the aim of eventually bridging the gap between information, resources, and access to specialists for Indian women from diverse backgrounds. Ms. Sharma commented, “The cost of this treatment is out of reach for many poor women in India.” Ms. Sangeeta indicated her resignation to living with pain. Dr. Satwik asserted that increased awareness must originate from the medical community, suggesting that discussions on menopause and perimenopause should be as frequent as those on fertility and adolescent health. Dr. Soni noted that the government already operates a network of healthcare workers in rural and remote regions. She proposed, “They already give supplements and provide health care services to pregnant women. Now extend that to menopausal women.”